The American Chiropractor Volume 36, Issue 6 | Page 60

When Opting Out
Isn i an Option
ot long ago, we heard from a panicked DC who
had just received a call from Medicare. Eeek!
They asked him why they had begun receiving
itemized statements from his patients when they
couldn't find him registered in the system. He
told them that his particular style of chiropractic was not classified as a chiropractic manipulative treatment (CMT) because
he was more of a sports chiropractor. He felt that he had "opted
out" of Medicare. His logic was that most of the patients in his
practice were a younger, more active clientele of athletes and
active adults, and he had very few Medicare patients. So mostly,
he felt he wasn't really providing Medicare-covered services.
Evidently, these patients thought he was.

N

The key word here would be "mostly." By the time we received the e-mail. this poor guy was in a panic, and for good
reason. Chiropractors can choose to be participating (par) or be
non-participating (non-par) providers of Medicare, but opting
out isn't an option. He had been treating Medicare-qualified
patients who thought they were seeing a typical chiropractor
who was enrolled in the Medicare system. Now they were
seeking reimbursement from either Medicare or their secondary
insurance on their own.

As a result, the chiropractor in question was receiving letters
and calls from Medicare telling him that he wasn't using the
proper modifiers, and the secondary insurances were demanding an "opt-out letter," which was something he wasn't even legally allowed to
do. He was confused and distraught, and
we were just plain worried. By the time
Medicare is sending you notices sniffing
for more info and wondering why in the
GETTING TO THE HEART OF THE MATTER
world your patients are sending in their
bills, you' re not just in hot water, you' re
FOR HEALTH AND VITALITY
gasping for air.

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A discouragingly large percentage of
DCs still believe they can "opt out" of
Medicare and demand cash from Medicare patients. That is not acceptable or
legal. Even if you are a "non-par" provider, you still must be equipped to be
able to bill Medicare, meaning that you
are enrolled with Medicare. This is as true
statutorily noncovered services as it is of
covered chiropractic manipulation. The
rules are simple: DCs must bill Medicare
directly for all covered CMT services and
for the statutorily excluded services if the
patients ask them to do so, such as for
denial in order to submit to a secondary
insurance.
Why? If a patient were to receive an
excluded service, such as an exam, the
secondary carrier might pay when Medi-

To learn more, circle # 128 on The Action Card
56 I The American Chiropractor I JUNE 201 4

www.t heamericanch iropractor.com